急性滤器相关下腔静脉血栓形成危险因素分析  

Analysis of the risk factors for acute filter-related inferior vena cava thrombosis

作　　者：张富钊 李静 郑国学 康藤耀 雍熙 陈镜全 谭强[1] 陈开[1] 郑江华[1] ZHANG Fuzhao;LI Jing;ZHENG Guoxue;KANG Tengyao;YONG Xi;CHEN Jingquan;TAN Qiang;CHEN Kai;ZHENG Jianghua(Department of Vascular Surgery,Affiliated Hospital of North Sichuan Medical College,Nanchong,Sichuan Province 637000,China)

机构地区：[1]川北医学院附属医院血管外科,四川南充637000 [2]四川省营山县人民医院外二科 [3]川北医学院临床医学系外科教研室

出　　处：《介入放射学杂志》2022年第1期27-32,共6页Journal of Interventional Radiology

基　　金：川北医学院2017年度博士科研启动基金(CBY17-QD01)。

摘　　要：目的探讨滤器置入术后发生急性滤器相关下腔静脉血栓形成(IVCT)的危险因素。方法选择2018年2月至2019年10月在川北医学院附属医院接受下腔静脉滤器置入治疗和影像学随访的86例深静脉血栓形成(DVT)患者,其中发生急性滤器相关IVCT患者19例(IVCT组),未发生滤器相关IVCT患者67例(对照组)。采用单因素分析两组患者临床和影像学资料,二分类logistic回归分析滤器置入术后发生急性滤器相关IVCT的危险因素,受试者工作特征曲线(ROC)分析变量参数,预测滤器置入术后发生急性滤器相关IVCT风险,找出最佳临界值。结果二分类logistic回归模型分析显示,两组患者术后下肢制动(OR=0.067,95%CI=0.011~0.411,P=0.004)、术后未规律抗凝(OR=0.104,95%CI=0.017~0.619,P=0.013)和下腔静脉直径(OR=1.466,95%CI=1.095~1.963,P=0.010)比较,差异均有统计学意义。ROC分析下腔静脉直径曲线下面积(AUC)为0.740,提示其预测滤器置入术后发生急性滤器相关IVCT的准确度较高。结论术后下肢制动、术后未规律抗凝及下腔静脉直径偏小是滤器置入术后发生急性滤器相关IVCT的独立危险因素。术后下肢活动、规律抗凝和密切观察下腔静脉直径较小患者,可能有助于减少急性滤器相关IVCT发生。Objective To investigate the risk factors for acute filter-related inferior vena cava thrombosis(IVCT)in patients with deep venous thrombosis(DVT)after receiving filter placement.Methods A total of 86 patients with DVT,who underwent inferior vena cava(IVC)filter placement at the Affiliated Hospital of North Sichuan Medical College of China between February 2018 and October 2019,were collected.Among the 86 patients,19 developed acute filter-related IVCT(IVCT group),and 67 didn’t develop acute filter-related IVCT(control group).Univariate analysis method was used to evaluate the clinical and imaging data of both groups.Binary logistic regression analysis method was used to analyzed the risk factors for acute filter-related IVCT after filter implantation.Receiver operating characteristic curve(ROC)was adopted to analyze the relevant variables,the risk factors for predicting the acute filter-related IVCT after filter implantation and the optimal critical value were determined.Results Binary logistic regression model analysis showed that the differences in postoperative immobilization of lower limb(OR=0.067,95%CI=0.011-0.411,P=0.004),postoperative irregular anticoagulation therapy(OR=0.104,95%CI=0.017-0.619,P=0.013)and IVC diameter(OR=1.466,95%CI=1.095-1.963,P=0.010)between the two groups were statistically significant.The area under curve(AUC)of IVC diameter was 0.740,which indicated that IVC diameter carried higher accuracy in predicting the occurrence of acute filter-related IVCT after filter implantation.Conclusion Postoperative immobilization of lower limb,postoperative irregular anticoagulation therapy and smaller IVC diameter are the independent risk factors for the occurrence of acute filter-related IVCT after filter implantation.After IVC filter implantation,encouraging patients to do lower limb activity,adopting regular anticoagulation therapy and closely observing the patients who has smaller IVC diameter may help reduce the occurrence of acute filter-related IVCT.

关 键 词：血栓形成 下腔静脉 滤器 危险因素 

分 类 号：R543[医药卫生—心血管疾病]